Is lithium justified after one manic episode?

Fifty-seven per cent of patients with a DSM III diagnosis of mania were discharged on lithium after the first admission. This group differed from those not prescribed lithium in terms of length of admission, severity of symptoms, sex and social class. Outcome was not influenced by prescription of this drug even though it was shown to be an effective prophylactic. The reasons for this are discussed and recommendations for future clinical practice are made.